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Croup

Advice for professionals

Croup is a common childhood illness that causes a bark like cough. It can also cause difficulty breathing which can be frightening for both you and your child.

Croup is caused by a virus which affects the airways including the voice box (larynx), windpipe (trachea) and lungs (the bronchi) causing them to swell and become narrower. 

Some children have croup two or more times in their childhood.

Related topics: bronchiolitis, cough and colds, difficulty breathing

Paediatric Pathway

To see the croup paediatric pathway click here.

When should you worry?

If your child has any of the following:

  • Breathing very fast, too breathless to talk, eat or drink

  • Working hard to breathe, drawing in of the muscles below the ribs 

  • Breathing that stops or pauses

  • A harsh noise as they breathe in (stridor) present all of the time (even when they are not upset)

  • Drooling more than normal and struggling to swallow their own spit

  • Is pale, blue, mottled and/or unusually cold to touch

  • Difficult to wake up, very sleepy or confused

  • Weak, high-pitched, continuous cry or can’t be settled

  • Has a fit (seizure)

  • Is under 3 months old with temperature more than 38°C or under 36°C (unless fever in the 48 hours following vaccinations and no other red or amber features)

  • Has a rash that does not go away with pressure (the ‘Glass Test’)

You need urgent help

Go to the nearest Hospital Emergency (A&E) Department or phone 999

If your child has any of the following:

  • Breathing a bit faster than normal or working a bit harder to breathe

  • A harsh noise as they breathe in (stridor) only when upset

  • Dry skin, lips or tongue

  • Not had a wee or wet nappy in last 8 hours

  • Poor feeding in babies (less than half of their usual amount)

  • Irritable (Unable to settle them with toys, TV, food or hugs even after their fever has come down)

  • Is 3-6 months old with temperature 39oC or above (unless fever in the 48 hours following vaccinations and no other red or amber features)

  • Temperature of 38oC or above for more than 5 days or shivering with fever (rigors)

  • Temperature less than 36°C in those over 3 months

  • Getting worse and I am still worried

You need to contact a doctor or nurse today

Please ring your GP surgery or call NHS 111 - dial 111

If symptoms persist for 4 hours or more and you have not been able to speak to either a member of staff from your GP practice or to NHS 111 staff, recheck that your child has not developed any red features

If your child has none of the above:

  • Watch them closely for any change and look out for any red or amber symptoms

  • Additional advice is also available for families for help cope with crying in otherwise well babies

  • If your child has a long term condition or disability and you are worried please contact your regular team or follow any plans that they have given you.

Self care

Continue providing your child’s care at home. If you are still concerned about your child, call NHS 111 – dial 111

This content has been developed by healthcare professionals from across the UK in collaboration with the RCPCH.

What are the symptoms of croup?

  • A cough. The cough is usually harsh and barking. This ‘croupy cough’ is due to inflammation and swelling of the vocal cords in the voice box (larynx).

  • Noisy breathing. The infection can narrow the voice box (larynx) and windpipe (trachea) and cause an extra noise called a stridor. This noise is normally heard on breathing in.

  • Breathing may become difficult if the narrowing becomes worse.

  • Your child may also have a runny nose, hoarse voice, sore throat, high temperature (fever), general aches and pains and be off their food. Croup may follow a cold but can also appear without any earlier illness. 

  • The symptoms of croup appear worse at night. A mild but irritating cough may persist for a further week or so.

How can I help my child?

  • Stay calm. This will help keep your child calm. Children with croup may become upset. Crying may make their symptoms worse.

  • Sit your child upright on your lap if their breathing is noisy or difficult. Let them find the most comfortable position.

  • Encourage your child to drink cool drinks regularly (little and often) to help soothe their throat and keep them hydrated.

  • If your child seems to be in pain or discomfort, you can give your child Paracetamol or Ibuprofen, following the instructions on the container.

  • If their temperature is high, dress them in cool, loose clothes (if any) and don’t use anything warmer than a sheet to cover them in bed.

  • Stay with your child or check him or her regularly. You need to know if the symptoms are getting worse.

  • Some people find that taking their child outside in the cool, fresh air helps to relieve their symptoms

  • There is no evidence that steam inhalation helps. There is a risk of scalds if steam is used.

  • Do not give cough syrup. It is not recommended for children under 6 years. It can make children sleepy and does not help croup.

How is croup treated:

  • Your child may be given a steroid medicine called dexamethasone or prednisolone which can reduce airway swelling

  • As croup is caused by a viral illness antibiotics are not needed.

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There are many sensory issues associated with sleep including:

  • Sensitivity to sound, touch, and visual stimuli which can be distracting and distressing and can affect the process of falling asleep.
  • Interoception difficulties, particularly recognising when hungry, full or thirsty or when the person is tired. 
  • Some children are more sensitive to foods like sugar, caffeine and additives which keep people awake.

Look at the bedroom environment to see what may be affecting their ability to go to sleep and stay asleep. Do their pyjamas and bedclothes feel comfortable, are they too hot or cold?  Is it too light or too dark, too noisy or too quiet? Perhaps it is too cluttered and stimulating. Think about your child’s diet. Are they eating too early or not having enough to eat? Are they eating food that can stimulate them close to bedtime. There can be added difficulties where children have restrictive diets but some simple adjustments of what is eaten and when can make a big difference. 

Click here for more information on sensory issues.
 

Sticking to the same routine helps your child to know what to expect at bedtime and helps them feel secure. It also helps to support your child’s internal body clock and keep it on track. The age related sleep advice and information on this website can help with establishing routines. Some children will benefit from using picture timetables, timers or social stories to help them understand their bed-time routine. More information about visual supports can be found on these websites

Visual Resources | Autism West Midlands 
Visual Supports | Autism Toolbox Autism Toolbox

Your child may be feeling overstimulated after a busy day and needs help to wind down, or their environment may be overstimulating with lots of toys, TVs and computers within reach. Avoiding TV and computers or hand-held devices an hour before bedtime can help your child to wind down. Activities that are good for the wind down period are jigsaws and colouring. Having a relaxing bath and milky drink can help some children, but for some children having a bath can over-excite them so they may need to have their bath earlier in the day.

Children who wake to use the toilet, wet the bed, or who wear nappies or pull-ups at night that need changing may have disturbed sleep. Eric, the children’s bowel and bladder charity are a good source of advice on this topic.

 

What might help 

Keeping a sleep diary 

A sleep diary can help you understand what may be causing difficulties with sleep. Fill it out every evening and record as much as you can. You can use it to spot patterns and make changes that may help. 

The Sleep Charity have templates you can download; one for teenagers and one for younger children. 

Seeking advice and help from sleep services 

There are organisations that can help you if you are having difficulties with your child’s sleep. There are many national organisations, including those who specialise in sleep for SEND families, and there are also community-based services in Shropshire, Telford and Wrekin. Click the link at the bottom of page to visit our support services page. 

Understanding sleep cycles 

The circadian sleep cycle is a 24-hour cycle that helps govern essential bodily functions especially the sleep-wake cycle. It plays a vital role in a person’s ability to sleep in one consolidated block of time at night and to stay awake during the day. As the sun sets in the evening, the brain begins producing melatonin, a hormone that induces sleepiness. Core body temperature also drops.

As melatonin and tryptophan (an amino acid which helps produce melatonin) are naturally produced in the body, there are things you can do to help their production.  Darkness helps to promote the production of melatonin which is why it is a good idea to put your child to sleep in a darkened room, and light emitting devices such as tablets and phones also can destroy melatonin so should not be used for at least an hour before bed. New research shows that limiting exposure to screens and increasing physical activity levels during the day has a positive effect on children's overall physical, mental health and wellbeing, including sleep.

Setting a waking time consistently even in holiday times, which is called ‘anchoring’ the wake time, can help to reset the body clock over time. This should be accompanied with exposure to lots of light on waking to support circadian rhythm. 

Melatonin and tryptophan occur naturally in some foods and drinks such as milky drinks and cereals which is why having a milky drink before bed can help settling to sleep. For more information visit Diet & Sleep - The Sleep Charity

Prescriptions of melatonin

Behavioural strategies and practical solutions are the best way to address sleep difficulties, but if they are having a significant impact on your child’s ability to function, a drug form of melatonin is sometimes prescribed for neurodivergent children. As the drug’s function is to re-set sleep and wake cycles, it works best combined with good sleep hygiene practices. It is important that is it taken under medical supervision and not purchased on-line so that it is closely monitored for dosage and side effects. It should be prescribed for the shortest period necessary as the long-term effects of the drug on children’s development are not yet known.

 In Shropshire, Telford and Wrekin the Community Paediatric Service and the CAMHS (BeeU) Service) can prescribe melatonin for children and young people who meet ALL of the following criteria.

  1. the child/young person must be open to and being treated by the service due to a neurodevelopmental/mental health need (diagnosis is not required but the child must be being seen by the service, not on a waiitng list)
  2. sleep issues are causing significant impact on the child/ young person, for example due to daytime sleeping or behavioural problems that are impacting daily functioning or educational attendance
  3. behavioural approaches have been tried and failed. These may have been offered by the service (where available) or by community sleep support services.

GPs are unable to prescribe melatonin although they sometimes issue repeat prescriptions when prescribing has been started by a specialist (such as a paediatrician or child psychiatrist). 

Further support 

Click on the link below to visit a page with information about

  • national websites and sleep organisations
  • local community services in Shropshire, Telford and Wrekin.